Endo Docs Gaming the System, Study Says
A study presented at Digestive Disease Week in Chicago last year suggests that physicians may be deliberately performing endoscopies on different days to avoid bundling—and the attendant reduction of payment—by Medicare payers, reports Internal Medicine News.
Researchers identified 12,905 Medicare beneficiaries who underwent both a colonoscopy and diagnostic upper endoscopy procedure within 180 days of each other. Nearly two-thirds of all procedures were bundled; the remaining procedures (approximately 37 percent) were separated from each other by a median of just 26 days, and approximately 30 percent of procedures not performed on the same day were separated by four or fewer days.
“The lack of bundling was unlikely to be explained by clinical necessity,” commented lead investigator Dr. Hashem B. El-Serag. Rather, El-Serag believes physicians making clinical choices may have been influenced by purely financial concerns.
Providing related endoscopic services on the same day is more convenient, efficient, and cost-effective, but there is a financial disincentive for physicians to embrace this approach. Medicare pays less when two endoscopic procedures are reported for the same patient on the same day. For example, reimbursement for a diagnostic upper endoscopy is approximately $75 when bundled; the payment nearly doubles ($150) if the procedure is reported independently.
The study stopped short of making recommendations to prevent such unbundling of endoscopic services, but lead researcher El-Serag did caution, “The financial implications to the health care system and the increased adverse events in patients are likely to be large.”